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Please check one: )L New Addition <br /> JOB SITE gl S ikJ I • t� r l4?-44-1 - <br /> Owner' s Name--- E :;, W S._ . Telephone Number <br /> Mailing Address r� <br /> Sprinkler Contractor' s Name ��,�, e.. cLx�. Telephone Number ¢1-/l 3 4, <br /> Contact Person 2x6 -AS . <br /> a S <br /> Mailing Address (9� ' 5l- WPI P i <br /> ******************** ********* *************** 4****************44**** <br /> CLASSIFICATION OF OCCUPANCIES <br /> Commercial Residential <br /> *************************************************************************** <br /> WATER SUPPLY <br /> Lake Well City <br /> *************************************************************************** <br /> Year of Orifice <br /> ake Model Manufacture Si e Quantity <br /> Sprinklers c, 1'19 Z• 1�g'% 9 7 <br /> TOTAL 9 7 <br /> *************************************************************************** <br /> HYDRAULIC CALCULATIONS Design Data: <br /> Area of Application: Zc99OVd Sq. Ft. <br /> Coverage per Sprinkler: 7.0 Sq. Ft. <br /> No. of Sprinklers: 9 r - n <br /> Total Water Required: (Do , *k GPM. <br /> ********************************o***** ************************************ <br /> PERMIT FEE CALCULATION <br /> 1 . Permit Fee $ 30 . 00 <br /> 2. State Surcharge. Based on valuation. $ .50 <br /> 3. Mail-In Fee $ 1. 50 <br /> 4. TOTAL PERMIT FEE add lines 1-3 above $ <br /> The undersigned hereby applies to the City of issuance of a Sprinkler <br /> System Permit, agrees to do all work in strict accordance with the <br /> ordinances of the City and State regulations, and certifies that all <br /> statements made on this application are complete, true and correct. <br /> Applicant - Date 7 27 <br /> PP <br /> ***************************** ********* * ******* ************************* <br /> Approved Approved with Corrections_ Denied <br /> 7--- <br /> Reviewed p . <br /> SI.4.4-4,------- <br /> Date <br />